Impact of insulin therapy on outcomes of diabetic patients with heart failure: A systematic review and meta-analysis

• Published in: Diabetes & vascular disease research 2022-05, Vol.19 (3), p.14791641221093175-14791641221093175
• Main Authors: Liu, Jingxing, Hu, Xinhua
• Format: Article
• Language: English
• Subjects: Diabetes Mellitus - diagnosis; Diabetes Mellitus - drug therapy; Diabetes Mellitus - epidemiology; Heart Failure - diagnosis; Heart Failure - drug therapy; Humans; Hypoglycemic Agents - adverse effects; Insulin - adverse effects; Myocardial Infarction - drug therapy; Review
• ISSN: 1479-1641; 1752-8984
• DOI: 10.1177/14791641221093175

Objective: To compare clinical outcomes in diabetic patients with heart failure managed by insulin with those managed by non-insulin (oral hypoglycemic agents and/or lifestyle modification) based therapy. Methods: PubMed and Scopus databases were searched for studies conducted on diabetic patients with heart failure. Studies were to compare outcomes of patients managed by insulin versus non-insulin therapies. Results: 15 studies were included. Compared to those who were managed using non-insulin therapy, insulin-treated patients had increased risk of all-cause mortality (RR 1.46, 95% CI: 1.14, 1.88) and cardiovascular specific mortality (RR 1.62, 95% CI: 1.33, 1.96). Those managed using insulin also had increased risk of hospitalization (RR 1.45, 95% CI: 1.09, 1.93) and readmission (RR 1.49, 95% CI: 1.32, 1.67). There was no additional risk for stroke (RR 1.07, 95% CI: 0.91, 1.27) or myocardial infarction (MI) (RR 1.10, 95% CI: 0.96, 1.27) between the two groups of patients. Conclusions: Receipt of insulin among diabetic patients with heart failure was associated with an increased risk of mortality, hospitalization and readmission compared to management using oral hypoglycemic agents and/or lifestyle modification. Such patients should be closely monitored for any adverse events.